Implementing an Evidence-Based Guideline to Improve Perioperative Antimicrobial Prophylaxis Quality Among Patients With Penicillin Allergy Labels

Objective To implement a quality improvement project to promote cefazolin for surgical antimicrobial prophylaxis (SAP) among patients with penicillin allergy labels (PwPAL) as updated guidelines suggest shifting SAP to preferred antibiotics (cefazolin) in PwPAL, including penicillin-associated anaphylaxis. Patients and Methods An interdisciplinary quality improvement project was conducted in a large, multiregion health care system in the United States to promote cefazolin for SAP among PwPAL. Interventions occurred January 1, 2023 through November 30, 2023 and were applied to adult and pediatric PwPAL undergoing operation. Broad system-based changes were implemented, including electronic health record allergy module enhancements, algorithm development, and point-of-care guidance to surgical clinicians through modifications to the electronic health record allergy-antibiotic flag at order entry and to surgical order sets. A dashboard was created to capture all SAP data, and education modules and communication articles were disseminated. Practice representative input was obtained, and frequent updates were provided through departmental meetings. Results Use of cefazolin for SAP in PwPAL improved 38% across all regions within our health care organization, increasing from 63.4% (8349/13,164) to 89.1% (12,988/14,569), P≤.001. No difference in use of medications for hypersensitivity or tryptase testing was noted between the preintervention cohort and postintervention cohort. Reductions in clindamycin, from 9.1% (1198/13,164) to 0.7% (100/14,569), P≤.001), and vancomycin, from 16.7% (2194/13,164) to 4.7% (691/14,569), P<.001) were also noted. Conclusion A successful increase in the use of cefazolin for SAP in PwPAL was achieved through broad quality improvement project implementation of system-based interventions without a corresponding increase in hypersensitivity surrogate markers.